Prevention of thromboembolism in patients with nonvalvular atrial fibrillation: From guidelines to clinical practice

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia with a rate as high as 13–15% in elderly subjects. AF is the most frequent cause of severe ischemic stroke and systemic embolism (embolism to limbs or viscera). Oral anticoagulation is highly efficacious for prevention in high risk patients with AF. Aim To assess current medical practice of oral anticoagulation treatment in a population of Greek patients with nonvalvular atrial fibrillation. Patients and methods A total of 200 consecutive patients who were admitted with documented chronic atrial fibrillation to a regional hospital in Greece were included in our study. ACC/AHA/ESC-criteria 2006 were used to define appropriate antithrombotic treatment for each individual patient. Patients with contraindications for anticoagulation were not included in our study. Results One hundred and nine (54.5%) were males. The five most common risk factors for stroke were age above 75 years (77.5%), hypertension (75%), heart failure (41%), diabetes mellitus (28%) and a history of strokes (22.5%). One hundred and seventy-six patients (88%) had indication for receiving anticoagulant therapy; however it was indicated in only ninety-six patients (54.5%). In other seventy-five patients antiplatelet agents (aspirine and clopidogrel) were used. Patients over 80 years received anticoagulants less frequently (p<0.001). Factors associated with the prescription of anticoagulants were history of previous embolic events (p<0.001), heart failure (p<0.02) and hypertension (p<0.03). Conclusions Most of the patients with chronic atrial fibrillation were elderly, had multiple concomitant risk factors for stroke and would benefit from anticoagulant therapy. However, only 54.5% of patients were treated with oral anticoagulation. Greater efforts are needed to improve the management of AF in high risk patients for thromboembolism.